| I/we*
hereby donate */ pledge to donate a tax deductible contribution payable to
Dakshineswar
Ramkrishna Sangha Adyapeath (DRSA, USA) for building
of the temple of Adya-Ma in New Jersey, USA, in the amount of |
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| US
$: __________________________ Check (if attached): No. ___________ |
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| Name: |
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| Address: __________________________________________ | ||
| City: __________________ |
State/Zip: _________________ |
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| Telephone:(____)___________ |
E-mail: ___________________________ |
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| In
the case of a pledge I/we* agree to pay the full amount of my/our* pledge within a month of being notified by DRSA, USA. |
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| *(Strike out whichever is not applicable) | ||||
| Please send all pledges / checks to DRSA, 1190 Easton Avenue, Franklin Township, NJ 08873, payable to DRSA, USA |